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The job quality and wages of home care workers are the focus of recently published articles in LeadingAge Magazine and BrainTrack.

“Ethical Workplaces” Needed

In LeadingAge, writer Dianne Molvig explains the need to create more “ethical workplaces” for home care employees.

“To me, an ethical home care organization is one that cultivates both quality care and quality jobs,” PHI Policy Research Director Dorie Seavey is quoted as saying in the article.

“High quality care is individualized and respectful,” Seavey continues. “High quality jobs provide a family-sustaining wage, affordable health insurance and respect for the worker, who gets excellent training and is allowed to participate in decision-making.”

Molvig uses PHI data to show that wages, retention, and overall working conditions for home care workers must improve if the U.S. hopes to keep pace with the increasing demand for such care.

She cites two organizations — Senior Independence in Columbus, Ohio, and Loretto’s PACE Central New York in upstate New York — as examples of ethical workplaces. Both organizations have invested in their workers in recent years, with positive results.

Revising FLSA Is “Win-Win”

The BrainTrack article, by Beth Panitz, focuses on the debate surrounding a proposed revision to the federal Fair Labor Standards Act (FLSA), which would extend minimum wage and overtime protections to home care workers.

“This revision would be an essential first step to stabilizing the home care workforce and positioning it to meet the demand we see coming,” Seavey is quoted as saying.

“We can raise the floor of these jobs in a way that’s win-win. We can attract more workers to these jobs so that we meet demand, and in so doing, it will improve the livelihood of workers,” Seavey adds.

Opponents of the proposed revision have argued that it will lower care quality by making it more expensive for home care companies to employ workers for 40 hours or more a week, which they say is necessary to establish care continuity. Seavey, however, told Panitz that “the notion that you get the best care when you have one aide working more than 40 hours a week is very questionable.

“We need a more modern approach to what continuity of care means,” Seavey added.

– by Matthew Ozga

A new report by the Older Women’s League (OWL) expresses support for a proposed revision to the Fair Labor Standards Act (FLSA) that would extend basic wage protections to home care workers.

The report, Women and the Workforce: Challenges and Opportunities Facing Women as They Age, examines the effect of the current job market on women aged 40 and older.

In the report’s “Policy & Legislative Recommendations” section, OWL states that FLSA should be amended “to extend basic labor protections, including minimum wage and overtime premium pay, to home care workers.”

Elsewhere, the report uses PHI data (pdf) to explain that ensuring quality jobs for direct-care workers is an important women’s rights issue; nearly 90 percent of direct-care workers are female, and their average age is 42.

Additionally, OWL’s report cites Partners in Care, the nation’s largest home health agency, as a model workplace for direct-care workers for its training and certification programs.

– by Matthew Ozga

(L-R) E.J. Dionne, Marki Flannery, PHI President Steven Dawson, Laine Romero-Alston

The Aspen Institute Workforce Strategies Initiative (Aspen WSI) convened an audience of 100 long-term-care and workforce development stakeholders in Washington, D.C., on May 3, for an expert discussion on the challenges that direct-care workers face and strategies workforce development leaders can use to improve the quality of these long-term-care industry jobs.

Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers, the thoughtful and lively discussion, was moderated by E.J. Dionne, a Brookings Institution senior fellow and Washington Post columnist, and featured:

• Steven Dawson, PHI President
• Marki Flannery, Partners in Care President, and
• Laine Romero-Alston, Ford Foundation Program Officer.

Maureen Conway, executive director of the Aspen Institute Economic Opportunities Program, framed the conversation by explaining that 40 percent of the jobs created since 2010 are low-wage jobs and direct-care occupations are the “lowest-paid jobs” with “uncertain hours.” She asked whether poor quality, direct-care jobs had “to be that way?”

Low-Wage, Not Low-Skill Jobs

Dawson explained the employment and income characteristics (pdf) of the direct-care workforce and that personal care aides and home health aides were projected to be the first and second fast-growing occupation in the nation by 2020.

He highlighted the particular challenges of home care workers, such as working in isolation and the need to have “emotional intelligence” to navigate a client’s home and the relationships within it.

“These are low-wage jobs but certainly not low-skill jobs,” Dawson said.

Valued and Respected

Flannery reported that her agency employs 9,800 home health aides — the largest licensed home care agency in the country — and described the profile of people seeking jobs as home health aides since the economic downturn.

Partners in Care has a turnover rate of 23 percent — significantly lower than the 60 percent national average, Flannery said. She attributes her agency’s high retention rate to its training partnership with PHI.

Using the PHI Coaching Approach^SM, Partners in Care’s managers, supervisors, and aides were trained in communication techniques that made the aides feel “valued and respected,” she explained, adding that the training also led to improved worker satisfaction and better patient outcomes.

Flannery also discussed the challenges of being a “high road employer” that pays aides a decent wage while reimbursement rates from public funding and private insurers go down.

Multi-Prong Strategies

Romero-Alston spoke on the importance of using “multi-prong strategies” to both “raise the floor” of direct-care jobs and “create opportunities for career pathways.” She identified a specific barrier to a good job that needed to be overcome: the exclusion of home care workers from basic labor protections such as minimum wage and overtime pay.

Romero-Alston added that the Obama Administration has “taken great strides” over the last few months to revise the so-called “companionship exemption” through a rule change proposed by the U.S. Department of Labor.

Video and Handout Available

To watch the discussion, including audience questions, an 80-minute video is available on the Aspen Institute website along with its overview (pdf) of the direct-care workforce.

“Better Care through Better Jobs: Improving Training and Employment for Direct Care Workers” was the Aspen WSI’s second discussion this year in a series entitled, “Reinventing Low-Wage Work: Ideas That Can Work for Employees, Employers and the Economy.”

– by Deane Beebe

A brief roundup of recent direct-care worker state news:

Court Rules That Missouri Home Care Workers Can Unionize

A state appeals court ruled May 1 that Missouri home care workers can unionize, ending their three-year battle to gain legal recognition as a union in the eyes of the state.

In 2009 and 2010, Missouri’s 13,000 home-care workers voted — by overwhelming margins — in favor of unionization. Both times, however, the votes were thrown out in court after anti-union activists challenged the results, alleging procedural flaws in the voting process.

Last week, however, a Missouri appeals court ruled that the state had to validate the 2010 election, thus clearing a path to the creation of a union for home-care workers.

The newly formed union, Missouri Home Care Union, is a partnership between SEIU and AFSCME.

Minnesota PCAs Temporarily Spared Wage Cuts

Proposed wage cuts to thousands of personal care aides (PCAs) in Minnesota were left out of the state’s latest Health and Human Services (HHS) budget, which Governor Mark Dayton (D) signed into law April 30.

The original HHS budget bill would have reduced state spending on PCAs by nearly $6 million. The cuts would have affected as many as 7,000 family caregivers who serve as PCAs to low-income relatives and receive payment through Medicaid.

The controversial cuts were deemed legal by a district judge in March after being challenged in court by eight Minnesota home care agencies. Despite the judge’s ruling, however, the legislature removed the cuts from the final budget sent to the governor.

Additionally, the budget bill postpones a $20.6 million rate cut to long-term care facilities. The postponement could give Minnesota enough time to negotiate a deal with the federal government, rendering the cut unnecessary.

Alabama Gov. Pushes for More Medicaid Funding

Alabama Governor Robert Bentley (R) vowed on May 2 that he would veto any General Fund budget bill that allots less than $602 million for Medicaid.

The governor’s announcement was a response to an early FY 13 budget proposal from state lawmakers that would have set aside just $400 million in Medicaid spending, 30 percent less than the FY 12 Medicaid allotment.

On May 8, a State Senate committee approved a budget bill that would devote $418 million of the General Fund to Medicaid, with the remaining $184 million to come from a line of credit from a state trust fund.

The credit line can only be created through a constitutional amendment, however. The state legislature is currently considering the amendment; if it passes, it will have to be approved by Alabama voters.

– by Matthew Ozga

Top home health franchises earn gross profit margins as high as 40 percent, making home care one of the five most profitable franchise ventures in the country, according to a report (pdf) by Franchise Business Review, a market research firm.

The report was highlighted in a recent USA Today article.

But despite these huge profits, the home health industry has spent hundreds of thousands of dollars fighting a proposed federal rule that would extend basic wage protections to home care workers.

Asked about this discrepancy by USA Today, PHI Policy Research Director Dorie Seavey said, “I find it really hard to reconcile that one of the most profitable sectors is pinching pennies when it comes to workers.”

Home health aides earned a median wage of $9.91 an hour (pdf) in 2011. Adjusting for inflation, that’s a 12 percent decline from their 2001 wages.

In December, President Obama proposed to end the “companionship exemption” in the federal Fair Labor Standards Act, which excludes home care workers from minimum-wage and overtime protections.

During a recent public-comment period, 26,000 comments on the proposal were submitted to the Department of Labor, of which three quarters were in support. Publication of a final rule could come as early as this summer.

– by Matthew Ozga

Home health aides in New Jersey held a rally on April 25 to voice their opposition to wage cuts proposed by their employer.

The aides, who provide in-home care for elders and people with disabilities, work for Personal-Touch Home Health Services, a large, for-profit home care company with locations in 13 states.

Personal-Touch is currently in contract negotiations with its 350 home health aides, who are represented by 1199 SEIU. During negotiations, Personal-Touch proposed instituting a sliding scale of rate-based cuts that would reduce many workers’ wages by as much as 30 cents an hour.

Dozens of Personal-Touch aides attended the rally, which was held outside the company’s Roselle Park branch, one of four Personal-Touch locations in New Jersey.

Lawmakers Join Rally

At the rally, the workers were joined by several members of the New Jersey General Assembly, who spoke in support of the aides.

Assemblyman Gary Schaer (D) told the gathered workers that his mother has received care from a home health aide for the last four years.

“That home health aide has been the difference to her between life and death,” he said. “Although you might think you are few in numbers, there are a whole lot of us standing right beside you.”

Assemblyman Joseph Cryan said that Personal-Touch must demonstrate that it values its workers by paying them fairly.

“For the lives you touch, you deserve a whole lot more than a pay cut,” Cryan said. “You deserve a pay raise, because what you do matters to people each and every day. When corporations make millions, they can spare 30 cents a head every hour.”

Additionally, 38 New Jersey lawmakers — including U.S. Senators Frank Lautenberg (D) and Robert Menendez (D) — signed a letter to Personal-Touch urging the company not to cut its workers’ wages.

– by Matthew Ozga